Touch Imprint Research Articles

Optimizing Endoscopic Respiratory Diagnostics with Cytology: An Update on Touch Imprints with a Comparative Literature Review.

Background: Major diagnostic and therapeutic changes led to the implementation of the 'lung cancer diagnosis in small biopsies and cytology specimens' concept in the WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart in 2015. Touch imprints are an established technique in cytology that provides a rapid and minimally invasive method for morphological diagnoses of clinical specimens, accurate subtyping, and molecular characterizations of malignancies. The extended diagnostic requirements from the increasingly limited material provided by minimally invasive biopsy techniques pose major challenges for pathology. Recognizing the relevant features and potential pitfalls is essential for cytologists to avoid misinterpretation. Materials and Methods: A retrospective analysis of endoscopic and surgical biopsy diagnostics was performed on 717 patients (303 women and 414 men; average age of 66.9 years) with clinically suspicious tumor findings at the LungenClinic Grosshansdorf in 2020. A total of 1363 cytological samples were obtained pre-therapeutically from 986 distinct biopsies covering 330 surgically and 656 endoscopically examined pulmonary, mediastinal, and bronchial regions. These samples were then compared with the histological diagnoses that were critical for determining the final therapy. Results: Out of a total of 656 endoscopically examined cases, 322 were classified as malignant, 308 as benign, and 26 as undetermined. While touch imprints and histological analysis separately achieved specificity values of 95.4% and 98.8%, both methods showed sensitivity values of 82.1% and 86.5%, respectively. In contrast, combining the two methods improved the sensitivity by 8 percentage points to 94.6%. Out of 330 cases of surgically examined samples, 137 were malignant, 190 were benign, and 3 were undetermined. The specificity of the morphological examinations for these samples was comparably high at 97.9% and 100%, respectively. In this surgical setting, touch imprints alone achieved a sensitivity of 75.9% (n = 104/137 cases), with a specificity of 97.9% (n = 186/190 cases). The outcome of the histological approach alone and in combination with touch imprints reached a sensitivity of 96.4% (n = 132/137 cases). Conclusions: Cytology and histology achieved comparably high sensitivity and specificity values on small biopsies. Under optimal conditions for morphological analysis in a surgical setting, the sensitivity of cytology for detecting malignant tumors was only 6 percentage points lower compared with the clinical endoscopic setting. A combined approach of cytologic-histologic evaluation for endoscopically examined specimens significantly increased the sensitivity by approximately 8% compared with the surgical setting (p < 0.003).

Utility of Touch Imprint Cytology for Evaluation of Pancreatic Masses in a Practice where Touch Imprints and Biopsy are Split between Cytopathology and Surgical Pathology Service in an Academic Institution

Utility of Touch Imprint Cytology for Evaluation of Pancreatic Masses in a Practice where Touch Imprints and Biopsy are Split between Cytopathology and Surgical Pathology Service in an Academic Institution

Viability of Whole-Slide Imaging for Intraoperative Touch Imprint Cytological Diagnosis of Axillary Sentinel Lymph Nodes in Breast Cancer Patients.

Whole-slide imaging (WSI) is a promising tool in pathology. However, the use of WSI in cytopathology has lagged behind that in histology. We aimed to evaluate the utility of WSI for the intraoperative touch imprint cytological diagnosis of axillary sentinel lymph nodes (SLNs) in breast cancer patients. Glass slides from touch imprint cytology of 480 axillary SLNs were scanned using two different WSI scanners. The intra- and interobserver concordance, accuracy, possible reasons for misdiagnosis, scanning time, and review time for three cytopathologists were compared between WSI and light microscopy (LM). A total of 4320 diagnoses were obtained. There was substantial to strong intraobserver concordance when comparing reads among paired LM slides and WSI digital slides (κ coefficient ranged from 0.63 to 0.88, and concordance rates ranged from 94.58% to 98.33%). Substantial to strong interobserver agreement was also observed among the three cytopathologists (κ coefficient ranged from 0.67 to 0.85, and concordance rates ranged from 95.42% to 97.92%). The accuracy of LM was slightly higher (average of 98.06%) than that of WSI (averages of 96.81% and 97.78%). The majority of misdiagnoses were false negative diagnoses due to the following top three causes: few cancer cells, confusing cancer cells with histiocytes, and confusing cancer cells with lymphocytes. This study is the first to address the feasibility of WSI in touch imprint cytology. The use of WSI for intraoperative touch imprint cytological diagnosis of SLNs is a practical option when experienced staff are not available on-site.

Rapid on-site evaluation of fine-needle aspiration specimens using cytotechnologist-performed telecytology: Insights and advantages.

With multiple health care centres expanding and implementing remotely controlled technologies, the role of cytopathology laboratories will become crucial in optimizing collection and assessment of small biopsy specimens for diagnosis and personalized treatment. Cytopathology services provide rapid assessments of samples obtained from fine-needle aspirations and occasionally core needle biopsies (analysed by touch imprints). Over the past few decades, the cost barrier for hospitals, especially small ones, to support a cytopathologist or cytotechnologist for rapid on-site evaluation (ROSE) has been reduced by the introduction of computerized microscopes that allow cytopathologists to perform ROSE without being present at the satellite laboratory (i.e. remotely). Utilization of the cytotechnologist's experience in ROSE alongside these technologies made it possible to perform ROSE with telecytology (ROSE-TC), which positively impacts diagnosis and treatment and also lowers the cost of care. The satellite laboratories that successfully implemented ROSE-TC operate with experienced cytotechnologists who, working independently between the cytopathology laboratory and the biopsy suite, prepare the smears and stain the slides on site for the distant cytopathologists, who can evaluate the slides remotely (usually from their office) simply using the facility intranet. This article aims to encourage big and small centres to use senior-level cytotechnologists for both ROSE and ROSE-TC. This article also defines different types of ROSE, explains our institution's approach to ROSE procedures, and outlines some experience-driven considerations for successful ROSE-TC and its future evolution.

Enhancing frozen section reporting for parathyroid masses: Integration of touch imprint as an adjunctive drill—A case report

ABSTRACT Parathyroid adenoma is a benign tumor of the parathyroid gland, typically causing primary hyperparathyroidism (PTPH) by autonomous overproduction of parathyroid hormone. A 34-year-old female presented with chronic abdominal pain radiating to the back and was found to have elevated levels of calcium in her blood. PTPH presenting with isolated edematous pancreatitis needs high suspicion in the Indian scenario. The utilization of the touch imprint technique in intraoperative frozen section analysis proved advantageous in this case. Offering rapid diagnosis within 2 min, compared with the standard 14 min, expedited surgical decision-making and enhanced patient care. The confirmation of parathyroid adenoma via touch imprint, supported by biochemical assays showing reduced serum parathyroid levels post-excision, underscored its diagnostic reliability. This highlights touch imprint’s significance as a valuable adjunct to frozen section reporting, especially in diagnosing parathyroid masses during surgery, this critical information aids surgeons in making informed decisions promptly, ensuring optimal patient outcomes and efficient healthcare delivery.

Performance of rapid on-site evaluation of touch imprints of bronchoscopic biopsies or lung tissue biopsies for the diagnosis of invasive pulmonary filamentous fungi infections in non-neutropenic patients.

The diagnosis of invasive pulmonary fungal disease depends on histopathology and mycological culture; there are few studies on touch imprints of bronchoscopic biopsies or lung tissue biopsies for the diagnosis of pulmonary filamentous fungi infections. The purpose of the present study was to explore the detection accuracy of rapid on-site evaluation of touch imprints of bronchoscopic biopsies or lung tissue biopsies for the filamentous fungi, and it aims to provide a basis for initiating antifungal therapy before obtaining microbiological evidence. We retrospectively analyzed the diagnosis and treatment of 44 non-neutropenic patients with invasive pulmonary filamentous fungi confirmed by glactomannan assay, histopathology, and culture from February 2017 to December 2023. The diagnostic positive rate and sensitivity of rapid on-site evaluation for these filamentous fungi identification, including diagnostic turnaround time, were calculated. Compared with the final diagnosis, the sensitivity of rapid on-site evaluation was 81.8%, and the sensitivity of histopathology, culture of bronchoalveolar lavage fluid, and glactomannan assay of bronchoalveolar lavage fluid was 86.4%, 52.3%, and 68.2%, respectively. The average turnaround time of detecting filamentous fungi by rapid on-site evaluation was 0.17 ± 0.03 hours, which was significantly faster than histopathology, glactomannan assay, and mycological culture. A total of 29 (76.3%) patients received earlier antifungal therapy based on ROSE diagnosis and demonstrated clinical improvement. Rapid on-site evaluation showed good sensitivity and accuracy that can be comparable to histopathology in identification of pulmonary filamentous fungi. Importantly, it contributed to the triage of biopsies for further microbial culture or molecular detection based on the preliminary diagnosis, and the decision on early antifungal therapy before microbiological evidence is available.

Comparison of Touch Imprint Cytology and Frozen Section for Evaluating Sentinel Lymph Nodes in Breast Cancer: A Study from a Tertiary Oncology Center in Upper Egypt

Comparison of Touch Imprint Cytology and Frozen Section for Evaluating Sentinel Lymph Nodes in Breast Cancer: A Study from a Tertiary Oncology Center in Upper Egypt

Commentary on "Fusion of old and new: Employing touch imprint slides for next-generation sequencing in solid tumors".

Commentary on "Fusion of old and new: Employing touch imprint slides for next-generation sequencing in solid tumors".

Comparison of Intraoperative Imprint Cytology versus Frozen Section for Sentinel Lymph Node Evaluation in Breast Cancer. A study along with Systematic Review and Meta-analysis of literature.

Sentinel lymph node (SLN) is the first lymph node to drain the lymph from a particular region involved by cancer. The commonly performed intraoperative methods for SLN evaluation are touch imprint cytology (TIC) and frozen section (FS). The present study aimed to determine the sensitivity, specificity and accuracy of TIC and FS with histopathological diagnosis as gold standard. The nodes were bissected along their long axis and wet surface was imprinted on to clean glass slides followed by toluidine blue and rapid Papanicolaou staining. Subsequently the lymph node slices were cut at three levels using the cryostat machine and stained with Hematoxylin and eosin stain. The cytological and FS findings were compared and the specificity, sensitivity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of TIC and FS was evaluated taking histopathological diagnosis as gold standard. In addition, pooled sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for touch imprint cytology and frozen section were assessed for the studies included in the meta-analysis. The specificity, sensitivity, diagnostic accuracy, positive predictive value and negative predictive value of touch imprint cytology were 100%, 88.2%, 90%, 100% and 60% respectively. The specificity, sensitivity, diagnostic accuracy, PPV and NPV of frozen section were 100%, 94.1%, 95%, 100% and 75% respectively. The sensitivity of TIC and FS for detection of micrometastasis was 60% and 80% respectively. The pooled sensitivity and specificity for touch imprint cytology were 85.24% (95% CI, 83.46%-86.90%), and 98.99% (95% CI, 98.69%-99.23%) respectively. The pooled sensitivity and specificity for frozen section examination were 90.45% (95% CI, 85.15%-94.34%), and 100% (95% CI, 99.24%-100%) respectively. Even though the sensitivity of FS was better than imprint cytology in detection of micrometastasis, TIC is a rapid inexpensive technique which can be utilized in remote areas in absence of cryostat machine. The sensitivity of the two techniques with respect to detection of macrometastasis was comparable. This meta-analysis highlights the accuracy of the touch imprint cytology and frozen section examination in the intra-operative detection of malignancy in breast cancer.

A Literature Review of the Diagnostic Utility of Touch Imprint Cytology in Lymph Node Lesions

Lymph nodes are encapsulated bean shaped structures, which function in mechanical filtration of lymph, along with recognition and processing of antigens. Pathology of the lymph node can be either inflammatory or neoplastic. Since they are easily accessible in most instances they can be easily submitted to FNAC, Imprint cytology or Biopsy. In this article we are reviewing the utility and effectiveness of touch imprint cytology which can be used in the intra operative diagnosis of lymph node conditions. An elaborate search of all the material related to the topic was carried out in various search engines such as Pubmed. Relevant research articles were shortlisted between the period 1927-2020. Our study reviewed all the work done in this field during this period. It was found that touch imprint cytology had an accuracy of up to 98.7%. The procedure has almost 100% specificity and up to 98.2% sensitivity. With several new diseases emerging, and patients seeking therapy at an early stage of sickness, early detection is critical for disease management. Lymph nodes are one of the most essential structures that serve as a perfect breeding for a variety of diseases. The problems faced with aspiration cytology and the lengthy waiting period for histopathology diagnosis can be overcome with touch imprint cytology providing a simple, rapid, and economical method of diagnosis.

Intraoperative Evaluation of Breast Tissues During Breast Cancer Operations Using the MasSpec Pen

Surgery with complete tumor resection remains the main treatment option for patients with breast cancer. Yet, current technologies are limited in providing accurate assessment of breast tissue in vivo, warranting development of new technologies for surgical guidance. To evaluate the performance of the MasSpec Pen for accurate intraoperative assessment of breast tissues and surgical margins based on metabolic and lipid information. In this diagnostic study conducted between February 23, 2017, and August 19, 2021, the mass spectrometry-based device was used to analyze healthy breast and invasive ductal carcinoma (IDC) banked tissue samples from adult patients undergoing breast surgery for ductal carcinomas or nonmalignant conditions. Fresh-frozen tissue samples and touch imprints were analyzed in a laboratory. Intraoperative in vivo and ex vivo breast tissue analyses were performed by surgical staff in operating rooms (ORs) within 2 different hospitals at the Texas Medical Center. Molecular data were used to build statistical classifiers. Prediction results of tissue analyses from classification models were compared with gross assessment, frozen section analysis, and/or final postoperative pathology to assess accuracy. All data acquired from the 143 banked tissue samples, including 79 healthy breast and 64 IDC tissues, were included in the statistical analysis. Data presented rich molecular profiles of healthy and IDC banked tissue samples, with significant changes in relative abundances observed for several metabolic species. Statistical classifiers yielded accuracies of 95.6%, 95.5%, and 90.6% for training, validation, and independent test sets, respectively. A total of 25 participants enrolled in the clinical, intraoperative study; all were female, and the median age was 58 years (IQR, 44-66 years). Intraoperative testing of the technology was successfully performed by surgical staff during 25 breast operations. Of 273 intraoperative analyses performed during 25 surgical cases, 147 analyses from 22 cases were subjected to statistical classification. Testing of the classifiers on 147 intraoperative mass spectra yielded 95.9% agreement with postoperative pathology results. The findings of this diagnostic study suggest that the mass spectrometry-based system could be clinically valuable to surgeons and patients by enabling fast molecular-based intraoperative assessment of in vivo and ex vivo breast tissue samples and surgical margins.

Rapid on-site evaluation of touch imprint cytology in navigation bronchoscopy for small peripheral pulmonary nodules.

Rapid on-site evaluation (ROSE) of cytopathology plays an important role in determining whether representative samples have been taken during navigation bronchoscopy. With touch imprint cytology (TIC), histologic samples can be assessed using ROSE. Although advised by guidelines, there have been almost no studies on the performance of TIC during navigation bronchoscopy. The objective of this study was to evaluate the value of TIC-ROSE (forceps/cryobiopsy) in combination with conventional ROSE (cytology needle/brush). In this single-center, prospective cohort study, patients who had pulmonary nodules with an indication for navigation bronchoscopy were consecutively included. The primary outcome of the study was the concordance of ROSE and the procedural outcome. The concordance rates of TIC-ROSE and the combination of TIC-ROSE plus conventional ROSE were compared. Fifty-eight patients with 66 nodules were included. Conventional ROSE and TIC-ROSE were assessable in 61 nodules (90.9%) each. By combining both ROSE techniques, all sampled lesions were assessable. Combining conventional ROSE with TIC-ROSE showed concordant results in 51 of 66 cases (77.3%) versus 44 of 66 (66.7%) and 48 of 66 (72.8%) concordant results for conventional ROSE and TIC-ROSE alone, respectively, compared with the procedural outcome. There was no indication of tissue depletion as a result of TIC. The combined ROSE approach had a statistically significant higher concordance rate compared with conventional ROSE alone. TIC-ROSE is a cheap, easily implementable technique that can result in higher concordant ROSE outcomes. This could lead to more efficient procedures and possibly higher diagnostic results. In a monomodality sampling setting with only histologic samples, TIC can provide ROSE.

Fusion of old and new: Employing touch imprint slides for next generation sequencing in solid tumors.

Cytomorphological evaluation of tissue touch imprints during rapid on-site evaluation or intraoperative pathology consultation has crucial value. However, literature on their utility for molecular testing is limited. In this study, we emphasize a further benefit of touch imprint slides and scrutinize our institutional experience on their use in molecular testing, specifically next generation sequencing (NGS). NGS-based reports (2019-2023) of Koç University Hospital were retrospectively analyzed and circumstances in which sequencing was conducted on touch imprint slides were retrieved (n = 18). Type/location of the biopsy, diagnosis, results, and quality metrics were recorded. Touch imprints were addressed when they harbored more neoplastic cells compared with permanent biopsies, when suboptimal fixation mitigated deoxyribonucleic acid/ribonucleic acid (DNA/RNA) yield in resections or when the sample was obtained from bone and required decalcification. Diagnoses were diverse, namely non-small-cell lung cancer, gastric adenocarcinoma, glial tumor, Ewing sarcoma, and carcinoma of unknown primary. The percentage of tumor cells on slides stretched between 15% and 70%. Molecular findings ranged from KRAS mutations to TRIM1::NTRK2 and EWSR::FLI1 fusions. For five cases, sequencing did not yield any alteration, one study was not completed because it did not yield high-quality RNA. Touch imprint slides provide a reliable alternative, especially when neoplastic cells are scarce in permanent biopsies or decalcification deters nucleic acid quality. Based on our experience, we suggest making touch imprints on a routine basis, especially for every bone biopsy. Once digitally scanned duplicates are made, original slides can be safely used for DNA-/RNA-based molecular studies.

Contemporary art of cell-block preparation: Overview.

Cell blocks (CBs) are paraffin-embedded versions of cytology specimens. These versions are contrasted with tissues made from surgical pathology specimens of formalin-fixed paraffin-embedded (FFPE) tissue. CBs enable various elective ancillary studies of a range of specimens. These studies include the potential to perform molecular tests with the enhanced cytopathological interpretation. CBs are increasingly reported in cytology specimens. The enhanced role of CBs incorporates additives with new markers for immunohistochemistry (IHC), including the multicolored approach to IHC, and the subtractive coordinate immunoreactivity pattern. Even when archived material is retrospectively retrieved, CBs are a major tissue source for many supplementary studies. The CBs have been qualitatively and quantitatively improved. CBs are significant since they have increased molecular markers standardized on FFPE tissue. High-quality CBs can serve as useful additions to cytological smear preparations and touch imprint cytology. Most cytological specimens, such as fine-needle aspirations, cavitary effusion, washings, brushings, and gynecological and non-gynecological liquid specimens, may be used to produce CBs. This review deals with the CB-making process and discusses various historical limitations with an emphasis on recent advances.

Intraoperative Touch Imprint Cytology of Brain Neoplasms: A Useful High-Diagnostic Tool in 93 Consecutive Cases; Differential Diagnoses, Pitfalls, and Traps.

Intraoperative cytological examination of central nervous system (CNS) lesions was first introduced in 1920 by Eisenhardt and Cushing for rapid evaluation of neurosurgical specimens and to guide surgical treatment. It is recognized that this method not only confirms the adequacy of biopsy in CNS samples but also indicates the presence and preliminary diagnosis of lesional tissue. A total of 93 patients who underwent touch imprint cytology (TIC) for CNS tumors or lesions between 2018 and 2023 were included in the study. All cases were correlated with the final histopathological diagnosis, and pitfalls and difficulties encountered with discrepancies were noted. The most common primary CNS tumors were gliomas and meningiomas, while secondary (metastatic) tumors were predominantly lung, breast, and gastrointestinal system carcinomas. Sensitivity, specificity, positive predictive value, and negative predictive value for diagnosis with TIC were 94.1%, 100%, and 61.5%, respectively. Final histopathological diagnosis by TIC was made in 88 cases (94.6%) and the discrepancy was found in 5 cases (5.37%). Three of the five discrepancies (3.2%) were haematolymphoid malignancies (two lymphomas and one plasma cell neoplasia), one glioblastoma, and one hemangioblastoma case. TIC is a fast, safe, and inexpensive diagnostic tool used during intraoperative neuropathology consultation. Awareness of the pitfalls of using this method during intraoperative consultation will enable high-diagnostic accuracy.

Touch Imprint Cytology in Oral Cancer Diagnosis: A Narrative Review

Touch Imprint Cytology (TIC) is a simple, economical, and cost-effective method that can be used as a rapid tool for tissue diagnosis. It has been used for the intraoperative diagnosis of cancer, evaluation of surgical cut margins, evaluation of sentinel lymph nodes, diagnosis of head and neck lesions, and postmortem diagnosis. Intraoperative diagnosis includes both frozen section and TIC, which provide rapid pathological consultation. Brush biopsy can also be used for cytological diagnosis and acts as an adjunct to histopathological and TIC diagnosis. It has been found that TIC yields satisfactory and adequate material for diagnosis, allowing early counselling and preparation of the patient for further processes without having to wait for the results of histopathology. As technology continues to evolve, ongoing research aims to enhance the utility and accuracy of TIC in oral cancer diagnosis. Advancements in imaging techniques, such as confocal microscopy and molecular analysis of TIC samples, hold promise for improving diagnostic sensitivity and specificity

Diagnostic Utility of Touch Imprint Cytology of Image Guided Core Needle Biopsy

Background: Touch imprint cytology of image guided core needle biopsy implies gentle rolling of core needle biopsy obtained with the aid of imaging modality from various organs. The aim of the study was to measure the diagnostic accuracy of touch imprint cytology of image guided core needle biopsy in comparison to histopathological diagnosis.&#x0D; Materials and Methods: A prospective descriptive cross-sectional study was conducted among 47 touch imprint cytology of image guided core needle biopsy in the department of pathology of a tertiary care centre between 1st October 2021 to 30th September 2022 after receiving ethical approval from the institutional review committee. The Papanicolaou and Giemsa-stained slides of touch imprint smear and haematoxylin - eosin-stained slides of core needle biopsy was analysed for adequacy and categorization as non-neoplastic, benign, atypical and malignant. Convenience sampling was done.&#x0D; Results: The most frequent site of image guided core needle biopsy was lung (40.4%). The adequacy rate of touch imprint cytology of image guided core needle biopsy was 85.1%. Among 40 cases of adequate touch imprint smear, 28 cases (70%) were categorized as malignant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of touch imprint cytology for categorizing a malignant lesion was 91.18%, 95.45%, 96.88%, 87.5% and 92.86% respectively.&#x0D; Conclusion: The touch imprint cytology of image guided core needle biopsy is a useful modality for the rapid preliminary diagnosis of lesions of various organs with decreased turnaround time for diagnostic workup and ancillary studies.

Intraoperative pathologic diagnosis of central nervous system lymphomas: A comparison of frozen and permanent section diagnoses, and the significance of preoperative imaging

BackgroundCentral nervous system (CNS) lymphomas, either primary or secondary in origin, are rare malignant tumors affecting the brain, spinal cord, or leptomeninges. Diagnosis of CNS lymphomas is complicated by their diverse clinical presentations, radiological features, and histopathological characteristics. Although frozen section (FS) analysis is commonly employed for various CNS tumors, its role and accuracy in CNS lymphoma diagnosis are less explored. In this study, we conducted a comparative analysis to assess the impact of knowledge of preoperative imaging on enhancing the accuracy of FS diagnosis in CNS lymphomas. MethodsData collection involved a retrospective review of CNS lymphoma patients from January 2009 to August 2021. Patients who underwent intraoperative consultation were included, excluding those with prior cortisone treatment. The dataset incorporated patient demographics, classification as primary or secondary lymphoma, radiological preliminary diagnoses, FS diagnosis, and permanent section diagnosis. We employed various archived materials, including FSs, touch imprint slides, crush cytology slides, H&E-stained sections, and immunohistochemical stains, and re-evaluated all slides for diagnostic validation. ResultsOur study included 25 patients, of whom 60 % were female and had a mean age of 56.5 years. Preoperative radiology data were available for 80 % of cases, with preliminary diagnoses commonly including lymphoma and/or metastasis. Intraoperative consultation results indicated lymphoma in 18 (72 %) patients, with discordance observed in 28 % of cases when compared to permanent section diagnoses. Most permanent section diagnoses were diffuse large B-cell lymphomas (92 %), with the remainder being T-cell non-Hodgkin lymphoma (4 %) and follicular lymphoma (4 %). Intraoperative misdiagnoses were significantly associated with the absence of knowledge of preoperative imaging. ConclusionOur study demonstrates the reliability of FS diagnosis for CNS lymphomas during surgery, with a favorable complete concordance rate of 72 % when compared to permanent diagnoses. Importantly, lack of knowledge of preoperative imaging significantly impaired diagnostic accuracy in FS, emphasizing the need for close collaboration between pathologists and radiologists.

Lymph Nodes Triaging by General Surgical Pathologists – Flow Cytometry or Immunohistochemistry or Both?

Abstract Introduction/Objective The diagnosis of lymphoma has become complex due to existing WHO/ICC classifications. Triaging Lymph Nodes (LN) is an important first step in making the correct and precise diagnosis in a timely and cost- effective manner, initiating appropriate treatment and predicting prognosis. Surgical Pathologists (SPs) face challenges when it comes to triaging LNs for Flow Cytometry (FC) and Immunohistochemistry (IHC), as limited guidelines are available for triaging and every practice doesn’t have hematopathologist (HP) on site. Methods/Case Report We retrospectively evaluated 850 LNs (excision, core or FNAs) during 2009-2022; and divided samples into two groups (without additional esoteric testing) that were blinded from each other: Group I: FC and morphology (460) and Group 2: IHC and morphology (390). Diagnostic categories (DC) were 1) Reactive (RE-140); 2) B-cell lymphomas (BLy-375); 3) T-cell lymphomas (TLy-75); 4) Hodgkin Lymphomas (HL-230) &amp; 5) Non-heme malignancy (NHM-30). Results (if a Case Study enter NA) Group I – Diagnosis was made independently in 5 DCs as follows: RE (90%); BLy (45%); TLy (10%); HL (10%) and NHM (20%). Group II – Diagnosis was made independently in 5 DCs as follows: RE (70%); Bly (80%); TLy (70%); HL (90%) and NHM (100%). Conclusion We concluded that touch imprints or cytological preparation are important steps when triaging LNs and summarize our findings as follows: 1) Combination of both FC and IHC are useful when triaging LNs; 2) FC overall results in cost savings; 3) FC is a powerful tool to be used for initial work-up and guiding further IHC work-up and diagnosis can be rendered faster when FC data is available; 4) FC is more valuable in RE and low grade BLy, while IHC in high grade BLy; 5) IHC is more valuable in TLy, HL and NHM. Therefore, it is imperative for pathology practices to prioritize the triaging of LNs initially for FC followed by IHC as needed.

The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients.

This meta-analysis aimed to evaluate the diagnostic accuracy of touch imprint cytology (TIC) for sentinel lymph node (SLN) metastases of patients with clinical node-negative early breast cancer. The PubMed, Web of Science, Embase, and the Cochrane Library databases were meticulously searched to retrieve literature published from January 2005 to September 2022 by two independent reviewers. The meta-analysis was performed using STATA16.0, Meta-Disc 1.4, and RevMan 5.4.9. According to the inclusion criteria, 4,073 patients from 13 studies were included in this meta-analysis. The pooled sensitivity and specificity of TIC for detecting SLN metastases were 0.77 (95% CI 0.66-0.85) and 0.99 (95% CI 0.97-1.00), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 76.15 (95% CI 29.16-198.84) and 0.23 (95% CI 0.15-0.36), respectively. The pooled diagnostic odds ratio was 326.82 (95% CI 132.76-804.56) and the area under the sROC curve was 0.97 (95% CI 0.95-0.98), respectively. This meta-analysis revealed that TIC with high sensitivity and specificity is a feasibility and accuracy diagnosis technique for intraoperative detection of SLN metastases in breast cancer.